Role of rehabilitation in chronic stress-induced exhaustion disorder: A narrative review

Abstract

LAY ABSTRACTThere has been an increase in cases of sick leave due to stress in several European countries in recent decades. Chronic stress-induced exhaustion disorder is linked with physiological and neurobiological changes, which may add to cognitive problems and long-term exhaustion. This narrative review summarizes the published evidence about the effectiveness of different interventions for the rehabilitation of patients with chronic stress-induced exhaustion disorder. Cognitive behavioural interventions and multimodal interventions reduce symptoms. Workplace interventions often improve return to work. Better sleep is associated with improvement of symptoms and return to work. Interventions for improving sleep might therefore be important. For improving cognitive function, which is a main complaint among patients with chronic stress-induced exhaustion disorder, aerobic and cognitive training may have some effect. Most interventions for the rehabilitation of chronic stress-induced exhaustion disorder have only marginal effects. Therefore, it is important to prevent the onset of this disorder. Objective: An increase in numbers of cases of sick leave due to stress have been reported from several European countries during recent decades. Chronic stress-induced exhaustion disorder is associated with physiological and neurobiological perturbations that may contribute to cognitive problems and longterm exhaustion. Rehabilitation of patients with chronic stress-induced exhaustion disorder is therefore challenging. This narrative review summarizes the evidence regarding the effectiveness of different interventions for the rehabilitation of patients with chronic stress-induced exhaustion disorder. Methods: Both structured and unstructured searches of research studies and reports were performed in order to find knowledge sources. The structured search had 2 predefined inclusion criteria: (i) chronic stress-induced exhaustion/clinical burnout/severe burnout/stress-induced exhaustion; and (ii) rehabilitation with improvement of symptoms and/or return to work as outcomes. Results: Cognitive behavioural interventions and multimodal interventions seem to reduce symptoms. Workplace interventions, either work-focused cognitive behavioural or workplace dialogue, seem to improve return to work. Sleep is important for both symptom improvement and return to work, and interventions for improving sleep might therefore be important. For improvement of cognitive function, which is a main complaint among patients with chronic stress-induced exhaustion disorder, aerobic and cognitive training may have some effect. Conclusion: In summary, the few studies of highquality that examine interventions for rehabilitation of chronic stress-induced exhaustion disorder show only marginal effects. Thus, it is important to prevent the onset of chronic stress-induced exhaustion disorder.

Restoring confidence in return to work: A qualitative study of the experiences of persons with exhaustion disorder after a dialogue-based workplace intervention

“…Between March and October 2016, 24 persons from seven CBT groups in the multimodal rehabilitation program were asked to participate in group interviews [34]. The persons included in this study each had a confirmed diagnosis of SED [6], were between the working ages of 18 to 60 years, had current employment, and were on at least 50% sick leave.…”

“…Work-directed interventions for burnout and mental disorders have most promising results for reduced sickness absence, even though the results are inconclusive [15][16][17][18]. Improved health symptoms do not automatically lead to improved RTW, and this confirms the need to develop interventions that bridge rehabilitation with organizational arrangements [13,15,18] and prevent the onset of SED at workplaces [6]. Interventions that initiate workersupervisor communication show interesting and positive outcomes [16,18,19,20].…”

“…Definition of burnout varies between countries [2]. In Sweden, stress-induced exhaustion disorder or exhaustion disorder (SED) (SED; F43.8A, ICD-10-SE) is classified as an illness and the diagnosis is used in Swedish healthcare practice [6]. SED is characterized by pronounced physical and mental exhaustion as a consequence of at least six months of identifiable stressors [7].…”

Hopeful struggling for health: Experiences of participating in computerized cognitive training and aerobic training for persons with stress‐related exhaustion disorder

“…Stress‐related ill‐health has increased dramatically in recent years in Sweden, and among these, exhaustion disorder (ED) is a common cause of sick leave (Swedish Social Insurance Agency, ). ED (F43.8A, ICD‐10‐SE) (National Board of Health & Welfare, ) is a criteria‐based diagnosis and used in Swedish clinical practice as a clinical manifestation of burnout (Grossi, Perski, Osika & Savic, ; Wallensten, Asberg, Wiklander & Nager, ). ED is characterized by psychological and physical exhaustion as a consequence of identified stressors (work‐ or non‐work‐related), present for at least six months (National Board of Health & Welfare, ).…”

“…Rehabilitation for persons with ED and clinical burnout has usually included cognitive behavioral interventions or multimodal interventions, but with no effect on symptoms or return to work compared with control groups (Grossi et al , ; Wallensten et al , ). The recovery time may be long with remaining symptoms and reduced work ability (Malmberg Gavelin, Eskilsson, Boraxbekk, Josefsson, Stigsdotter Neely & Slunga Järvholm, 2018; Stenlund, Nordin & Slunga Järvholm, ) and symptoms of exhaustion are persistent (Glise, Ahlborg & Jonsdottir, ).…”